中国实用外科杂志

中国实用外科杂志 ›› 2010, Vol. 30 ›› Issue (10): 863-866.

• 论著 • 上一篇    下一篇

甲状腺微小癌治疗选择

代文杰，朱化强，姜洪池   

  1. 哈尔滨医科大学附属第一医院普外科，黑龙江哈尔滨 150001
  • 出版日期:2010-10-01 发布日期:2010-09-28

  • Online:2010-10-01 Published:2010-09-28

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摘要：

【摘要】    目的    探讨甲状腺微小癌（TMC）的治疗选择。 方法    回顾性分析哈尔滨医科大学附属第一医院2002年1月至2007年1月收治的141例TMC的临床资料。根据病人不同的确诊过程选择不同的手术方式进行治疗，分析其疗效，并对淋巴结转移的影响因素进行了分析。 结果    术前或术中确诊的117例病人根据不同情况行患侧腺叶全切+峡部切除+对侧腺叶次全切或双侧腺叶全/近全/次全切除术，术后仅4例复发（3.4%）。术前和术中均诊断为甲状腺良性疾病，而术后病理连续切片才偶然发现的24例TMC中，21例由于无淋巴结转移且已行患侧次全切除术，未发现包膜和血管受侵犯，切除组织边缘无癌细胞浸润，病灶为单发，因此未行二次手术扩大切除范围，无一例复发。颈部淋巴结肿大的27例病人行淋巴结清扫，其中3例复发，复发率为11.1%，而未行淋巴结清扫的114例病人有2例复发，复发率仅为1.8%，显著低于前者（P＜0.05）。 结论    对TMC应采用个体化治疗方案，根据不同类型的病例采取不同的手术方式和治疗策略。TMC有一定的淋巴结转移率，多发病灶、有包膜浸润、直径≥5mm是影响淋巴结转移的重要因素。出现颈部淋巴结肿大的病人应行淋巴结清扫术，但对无淋巴结肿大者不必进行预防性淋巴结清扫。

关键词: 甲状腺肿瘤, 微小癌, 淋巴结清扫术

Abstract:

Treatment of thyroid microcarcinoma        DAI Wen-jie, ZHU Hua-qiang, JIANG Hong-chi. Department of General Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
Corresponding author: DAI Wen-jie,, E-mail: wenjdai@yahoo.com.cn
Abstract    Objective    To study on the treatment of thyroid microcarcinoma. Methods    Retrospective study was performed on the treatment of 141 cases of thyroid microcarcinoma admitted between January 2002 and January 2007 at the First Affiliated Hospital of Harbin Medical University. Different extent of thyroidectomy and lymphadenectomy were performed on different patients according to their diagnostic procedures. Therapeutic effect of different treatments and the factors associated with the presence of lymph node metastases were analyzed. Results    One hundred and seventeen cases were diagnosed preoperatively or intraoperatively, and were treated with ipsilateral total lobectomy +isthmusectomy + contralateral subtotal lobectomy, or bilateral total / near-total / subtotal thyroidectomy.  Four of them recurred (3.4%). Twenty-one cases were diagnosed as benign thyroid diseases preoperatively and intraoperatively, but incidentally detected as malignancy after the operation. They were firstly treated with ipsilateral subtotal lobectomy. Reoperation was not performed because all of them were single focal without capsular or vascular effraction. None of them recurred. Lymphadenectomy was performed in 27 cases with lymphadenectasis, and 3 of them recurred (11.1% ). Lymphadenectomy was not performed in another 114 cases without lymphadenectasis, and only 2 of them recurred (1.8%). Conclusion The surgical treatment of thyroid microcarcinoma should be individualized based on the patient and tumour. Lymph node metastases are common in thyroid microcarcinoma patients. The factors correlated with the presence of lymph node metastases were multifocal, capsular effraction, and tumor size (≥5mm). Lymphadenectomy is necessary for patients with lymphadenectasis, but is unnecessary for patients without lymphadenectasis.

Key words: thyroid neoplasms, microcarcinoma, lymph node dissection